Collaborative vs Non-Immersive VR in Parkinson's Rehabilitation (CVE vs NIVR)

April 11, 2026 updated by: Hafiz Muddassir Riaz, Superior University

COMPARATIVE EFFECTIVENESS of COLLABORATIVE VIRTUAL ENVIRONMENT and NON-IMMERSIVE VIRTUAL REALITY in the REHABILITATION of PATIENTS With PARKINSON'S DISEASE

This randomized controlled trial aims to compare the effectiveness of a Collaborative Virtual Reality Environment (CVE) and Non-Immersive Virtual Reality (NIVR) in the rehabilitation of patients with Parkinson's disease. Participants with mild to moderate disease severity will be randomly assigned to either the CVE group or the NIVR group.

The CVE intervention will involve therapist-guided, interactive virtual exercises in a shared environment, promoting real-time engagement and feedback. The NIVR group will perform task-oriented exercises using screen-based virtual reality without immersive and collaborative features.

Both interventions will be delivered over an 12-week period. Primary outcomes will assess motor function using standardized clinical scales, while secondary outcomes will evaluate cognitive function, mobility, and quality of life.

The study seeks to determine whether collaborative and interactive virtual rehabilitation provides superior clinical outcomes compared to conventional non-immersive virtual approaches in patients with Parkinson's disease.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

This study is designed to investigate the comparative therapeutic value of two distinct virtual reality-based rehabilitation teatement in individuals diagnosed with Parkinson's disease. The focus is on understanding how differences in interaction design, immersion level, and therapist involvement influence clinical outcomes.

The intervention framework is structured around task-oriented, goal-directed activities targeting both motor and cognitive domains commonly affected in Parkinson's disease. The Collaborative Virtual Reality Environment (CVE) incorporates a shared virtual space where the patient and therapist interact synchronously. This setup enables real-time guidance, adaptive feedback, and enhanced engagement through social and therapeutic presence. In contrast, the Non-Immersive Virtual Reality (NIVR) condition delivers similar rehabilitation tasks via a conventional screen-based interface without immersive or collaborative elements, relying primarily on self-directed patient interaction.

The rehabilitation protocol emphasizes functional movement patterns, including upper limb coordination, gait-related tasks, and balance. The virtual exercises are designed to align with established neurorehabilitation principles such as repetition, task specificity, and feedback-driven motor learning. Progression within the intervention is structured through graded task difficulty and performance-based adjustments.

Outcome evaluation focuses on quantifying changes in motor performance, cognitive function, functional mobility, and health-related quality of life using validated clinical instruments. Data will also be used to explore the relationship between user engagement characteristics and rehabilitation outcomes.

The study aims to generate evidence on whether integrating collaboration and immersion into virtual rehabilitation environments offers clinically meaningful advantages over conventional non-immersive approaches, thereby informing future design and implementation of technology-assisted neurorehabilitation systems.

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54000
        • Recruiting
        • Punjab Institute of Neurosciences Lahore

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Male and Female
  • Age: 45 years-80 Years
  • Diagnosed patients of idiopathic Parkinson Disease with minor to moderate severity according to the Hoehn & Yahr stages I-III.
  • On conventional and stable medical treatment at present
  • No severe cognitive impairments (MMSE ≥ 24).
  • Ability to participate in virtual rehabilitation sessions
  • Willingness to participate and provide informed consent

Exclusion Criteria:

  • Severe visual, auditory, or motor impairments unrelated to Parkinson's.
  • Fear of virtual environment.
  • Comorbidities that hinder participation in the treatment (e.g., advanced dementia).
  • Severe musculoskeletal conditions limiting movement
  • History of epilepsy or conditions contraindicating virtual reality exposure
  • Participation in another interventional study within the last 3 months

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: CVE

Participants in this arm will receive rehabilitation through a Collaborative Virtual Reality Environment (CVE), where both the patient and therapist interact simultaneously within a shared virtual space. The intervention is delivered using a head-mounted display-based system that enables real-time communication, guidance, and feedback.

The rehabilitation program consists of task-specific, goal-oriented exercises targeting upper limb function, gait, balance, and functional mobility. Activities are designed to simulate real-world movements and include object manipulation, reaching tasks, and controlled walking scenarios. The therapist actively supervises and adapts the exercises during each session, ensuring appropriate progression based on patient performance.

The collaborative nature of the environment facilitates increased engagement, motor learning, and adherence by incorporating interactive elements and immediate corrective feedback. The intervention follows structured progressio
Other: Collaborative Virtual Environment
Collaborative Virtual Reality Environment (CVE), participants perform exercises within a shared virtual space alongside a therapist, enabling real-time interaction, guidance, and adaptive feedback.
Other: NIVR

Participants in this arm will undergo rehabilitation using a Non-Immersive Virtual Reality (NIVR) system delivered through a standard screen-based interface. The intervention without the use of head-mounted displays or real-time collaborative features.

The rehabilitation program includes task-oriented exercises focusing on upper limb function, balance, gait-related activities, and overall functional mobility. These exercises are designed to replicate real-world movements and are performed in a structured and repetitive manner to promote motor learning.

Participants will perform the activities independently with periodic supervision from a therapist. Feedback is primarily system-generated, and progression is based on predefined levels of difficulty within the software. The intervention emphasizes consistency, task specificity, and gradual progression throughout the study
Other: Non-Immersive Virtual Reality (NIVR)
Physiotherapy-based rehabilitation delivered through a screen-based virtual environment, involving structured, task-oriented exercises performed with limited therapist interaction

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
MDS-UPDRS-III
Time Frame: From enrollment to the end of treatment at12 weeks

The MDS-UPDRS-III is a clinician-administered scale used to assess motor impairment in individuals with Parkinson's disease. It evaluates key domains including bradykinesia, rigidity, tremor, postural stability, and gait through a series of standardized physical examination items.

Each item is scored on a 5-point ordinal scale ranging from 0 (normal) to 4 (severe impairment), with higher total scores indicating greater motor dysfunction. The scale provides a comprehensive measure of motor severity and is widely used in both clinical and research settings due to its strong reliability and validity.

Changes in MDS-UPDRS-III scores over time will be used to determine the effectiveness of the intervention in improving motor function.
From enrollment to the end of treatment at12 weeks
Timed Up and Go (TUG) Test
Time Frame: Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)

The Timed Up and Go (TUG) Test is a standardized clinical measure used to assess functional mobility, balance, and risk of falls in individuals with Parkinson's disease. The test requires the participant to stand up from a seated position, walk a distance of approximately 3 meters, turn around, walk back to the chair, and sit down.

The total time taken to complete the task is recorded in seconds. Shorter completion times indicate better functional mobility and balance performance, whereas longer times may reflect impaired mobility and increased fall risk. The TUG test is widely recognized for its simplicity, reliability, and sensitivity to changes following rehabilitation interventions.
Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Falls Efficacy Scale-International (FES-I)
Time Frame: Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)

The Falls Efficacy Scale-International (FES-I) is a standardized, self-reported questionnaire used to assess concern about falling during a range of daily activities in individuals with movement disorders, including Parkinson's disease. It evaluates both basic and more demanding physical and social activities, providing a comprehensive measure of fall-related self-efficacy.

The scale consists of 16 items, each scored on a 4-point Likert scale ranging from 1 (not at all concerned) to 4 (very concerned). The total score ranges from 16 to 64, with higher scores indicating greater fear of falling and lower confidence in performing daily activities safely. The FES-I has demonstrated strong reliability, validity, and cross-cultural applicability in clinical and research settings.
Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)
Parkinson's Disease Fatigue Scale (PFS-16)
Time Frame: Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)
The Parkinson's Disease Fatigue Scale (PFS-16) is a disease-specific, self-reported instrument used to evaluate the impact and severity of fatigue in individuals with Parkinson's disease. It consists of 16 items focusing on physical fatigue and its effect on daily functioning. Scores are calculated based on patient responses, with higher scores indicating greater fatigue severity. Scale generally uses a 1-5 scoring system, resulting in minimum and maximum average scores of 1.0 (no fatigue) and 5.0 (extreme fatigue), respectively, with minimum 16 and maximum 80 Score.
Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)
Action Research Arm Test (ARAT)
Time Frame: Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)
The Action Research Arm Test (ARAT) is a performance-based assessment used to evaluate upper limb function. It measures the ability to perform tasks involving grasp, grip, pinch, and gross arm movement through a series of standardized activities. Each task is scored on an ordinal scale, with higher scores indicating better upper limb function and coordination. The tool assess upper extremity performance, with a total score range from 0 to 57.
Assessed at baseline (pre-intervention) and at the end of the intervention period (12 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Superior University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 27, 2025

Primary Completion (Estimated)

September 27, 2026

Study Completion (Estimated)

September 30, 2026

Study Registration Dates

First Submitted

April 5, 2026

First Submitted That Met QC Criteria

April 5, 2026

First Posted (Actual)

April 13, 2026

Study Record Updates

Last Update Posted (Actual)

April 15, 2026

Last Update Submitted That Met QC Criteria

April 11, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PhD/RS-4623-A

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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